Summary
Eccentric training is commonly used in many kinds of tendinopathy, but doesn’t have great evidence for use with rotator cuff tears yet. We still don’t know the appropriate protocol/dosage to use, and treatment may have to be highly individual.
Study Questions
What causes rotator cuff tendinopathy?
Excessive mechanical load
What’s so important about eccentric contractions? And why do they work well for tendinopathy?
- They generate greater muscle fiber tension during lengthening
- They create high frequency oscillations in tendon force
- They decrease vascular activity
- They help with pain adaptation
What determines the strength and elasticity of tendons?
- The amount, type, and arrangement of extracellular matrix
What part of the supraspinatus is stronger?
The anterior portion has greater tension and is bipennate. The posterior portion is thin and arranged in parallel.
What are components of the rotator interval?
- Supraspinatus
- Subscapularis
- Superior Glenohumeral Ligatment
- Coracohumeral Ligament
What are tendons made up of?
- Primarily Type I collagen (95%)
What is the most commonly injured shoulder tendon?
- Supraspinatus (via impingement)
What is the histology of tendinosis?
- Tendon widens
- Collagen distribution is disorganized
- Neovascularization
- Increased cellularity (decreased matrix I assume)
What are common sites of tendinosis?
- Achilles
- Patellar
- Wrist Extensors
- Supraspinatus
What do healing and degeneration of a tendon depend on?
- Mechanical load & stress modify cellular activity and tendon structure
What are the phases of tendon healing?
- Inflammatory (1-7 days)
- Repairing (1-5 weeks)
- Remodeling (6 – 10 weeks)
What does Anamnesis mean?
- The patient history
- (Plato) The rememberance of things from past lives
When is it best to begin loading a tendon for healing?
- As soon as pain allows
Camargo, P. R., Alburquerque-Sendín, F., & Salvini, T. F. (2014). Eccentric training as a new approach for rotator cuff tendinopathy: Review and perspectives. World journal of orthopedics, 5(5), 634.